key: cord-0050388-so53dm5q
authors: Collins, Jannette
title: Letter from the Editor: When Do You Need Colon Cancer Screening?
date: 2020-09-20
journal: Semin Roentgenol
DOI: 10.1053/j.ro.2020.09.005
sha: 770c8dc60e9a600ef6ac1934ea2f1143c6201611
doc_id: 50388
cord_uid: so53dm5q

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Jannette Collins, MD, MEd, FACR, Editor-in-Chief

Letter from the Editor: When Do You Need Colon Cancer Screening?

As a physician, I feel that it is my responsibility to promote recommended screening examinations. As a patient, I want access to the best available information so that I can choose to undergo screening or not, based on research-driven recommendations as applied to my personal history. I'm using this Letter as an opportunity to discuss some of the known facts about screening for colon cancer and relate some real-life patient stories.

Here are facts and guidelines for colon cancer screening from The Centers for Disease Control (CDC) [1] :

 If you are age 50 to 75 years old, you should get screened for colorectal cancer.

 The U.S. Preventive Services Task Force recommends screening beginning at age 50 [2] . Some groups recommend starting earlier, at age 45.

 The vast majority of new cases of colorectal cancer (about 90%) occur in people who are 50 or older.

 Millions of people in the United States are not getting screened as recommended. They are missing the chance to prevent colorectal cancer or find it early, when treatment often leads to a cure.

 If you think you may be at increased risk for colorectal cancer, learn your family health history and ask your doctor if you should begin screening before age 50.

The American Cancer Society recommends the following [3] :

 People at average risk of colorectal cancer (e.g., they do not have a personal history of colorectal cancer or certain types of polyps, a family history of colorectal cancer, a personal history of inflammatory bowel disease (ulcerative colitis or Crohn's disease), a confirmed or suspected hereditary colorectal cancer syndrome, such as familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary non-polyposis colon cancer or HNPCC), or a personal history of getting radiation to the abdomen or pelvic area to treat a prior cancer) should start regular screening at age 45.

 People who are in good health and with a life expectancy of more than 10 years should continue regular colorectal cancer screening through the age of 75.

 For people ages 76 through 85, the decision to be screened should be based on a person's preferences, life expectancy, overall health, and prior screening history.

 People over 85 should no longer get colorectal cancer screening.

There are several colon cancer screening tests, each with its own benefits and limitations. Fecal immunochemical tests, guaiac-based fecal occult blood tests, and stool DNA tests are convenient as they don't require bowel prep, but they can miss many polyps and some cancers. Most people will choose between colonoscopy or CT colonography after taking the following into consideration: On average, 30% of us who should be screened for colorectal cancer don't get tested -and that was before the COVID-19 pandemic. Colorectal cancer screening dropped 86% during the pandemic relative to averages prior to January 20, 2020 [4] .

If you're hesitant to be screened (and you wouldn't be alone in feeling this way), you might be persuaded by some personal stories [5] : To make a long story short, at the age of 52, I was diagnosed with rectal cancer. I was fortunate. My cancer was in the early stages, and surgery offered me a cure."

Joyce, Washington, D.C.

"In 1992, my husband and sister were diagnosed with colon cancer. They died within four months of each other. He had just turned 60 and my sister was 63. My husband had been in very good health, exercised religiously, ate a healthy diet, and got regular physicals by his internist. However, he did not get a colonoscopy. My sister was afraid of going to the doctor and did not want to get a colonoscopy. They both died unnecessarily."

"Both my father and grandfather died of colon cancer-that's what motivates me to get screened. To have the ability to check things before they get too far along is reassuring. My father did not get screened. It actually wasn't until he had some symptoms that he went to the doctor and they found the cancer. Unfortunately, at that point it had already spread."

You can read more stories from real patients at the Centers for Disease Control website [5] . Each individual account is an anecdote, but the research backs up screening.

Here's my story:

I got my first colonoscopy at age 50. I didn't like the prep, but the procedure was a piece of cake and I was delighted to learn that everything was normal. When I had my second colonoscopy at age 60, I woke up from sedation with abdominal pain, due to a pneumoperitoneum that resulted from piecemeal removal of a 2.5 cm sessile serrated polyp in the ascending colon. I spent the night in the hospital out of precaution, and went home the next day able to eat normally. The polyp was benign, but its histology is an indicator of an increased risk of developing colon cancer, so I now get colonoscopies every 3 years. My story emphasizes two things about colonoscopy screening: 1) complications, even serious complications, do occur, and 2) in the hands of a good colonoscopist, a sessile polyp, located in a challenging area of the colon, can be removed in its entirety so that it doesn't develop into a malignancy.

I encourage you to discuss the recommendations for colon cancer screening with your doctor so that you can make a decision that is right for you. Even if you aren't of an age to be screened, I encourage you to become informed -you might pass on what you know to a friend or loved one -you might even save a life.

I thank Dr. Lalwani and the excellent authors he recruited for creating this outstanding issue on the imaging of colorectal cancer.

Preventive Services Task Force. Colorectal Cancer: Screening

Colorectal Cancer Screening Tests

Preventive Cancer Screenings During Covid-19 Pandemic. Epic Health Research Network